• Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services
• Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference
• Record after-call actions and perform post-call analysis for the claim follow-up
• Assess and resolve inquiries, requests, and complaints through calling to ensure those customer inquiries are resolved at the first point of contact
• Provide accurate product service information to the customer, research available documentation including authorization, nursing notes, medical documentation on client's systems, interpret explanation of benefits received, etc prior to making the call
• Perform analysis of accounts receiva
Medical Billing Specialist: Handles day-to-day billings, maintains and grows payor relationships, and ensures optimal billing processes. Depending on the volume of billings, this may also involve specialists in Medicare and Medicaid Follow-up as well as Commercial Payor Follow-up.
• Medical Claims Denial Specialist: Identifies root causes of insurance denials, sends appeals to payors, and strives to minimize lost revenue. (. Denial Resolution Specialists, Claim Submission Resolution Specialist).
• AR Resolution/Collections Specialists: Collaborates with consumers and insurance representative to resolve outstanding obligations in a fair and timely manner.
• Medical Patient Collections Specialists: Collects patient liabilities that occur when patients are uninsured or have deductibles and coinsurance due. They may assist patients with setting up payment plans or refer them to eligibility professionals to explore additional reimbursement resources
• Patient Access Representative: Acquires and records demographic and reimbursement data for use in patient care, medical record and revenue cycle activities. Accurate and complete registration is critical for obvious reasons.